Nutritional Assessment Flashcards
What is the A.S.P.E.N definition of malnutrition
acute, sub-acute or chronic state of nutrition, in which varying degrees of overnutrition or undernutrition with or without inflammatory activity have lead to a change in body composition and diminished function
What causes a patient to be described as undernutrition, what percentage of patient’s fit this category
Lack adequate calories, protein or other nutrients due to inadequate intake, impaired absorption or altered metabolism/15-60% of hospitalized patients
What is kwashiorkor, how fast is it, patient descritption
Loss of visceral protein levels (albumin,leukocytes, granulocytes), preservation of body muscle and fat. rapid onset, shift of fluid into the stomach and legs
What is marasmus, how fast is it
Loss of skeletal muscle and body fat but preservation of vsiceral proteins, slow onset
How can a patient get a mix of kwashiorkor and marasmus
Patients with a chronic disease also get an acute disease as well
What are the steps to the nutrition care process
1) Screening and assesment 2) Diagnosis 3) Intervention 4) Monitoring and Evaluation
What is the purpose of nutrition screening
To quickly identify individuals who are malnourished or at nutritional risk and to determine if a more detailed assesment is warranted (done in 24 hours of hospital admission)
What is the most reliable and easiest tool to test screen nutrtion
Malnutrition Universal Screening Tool (MUST)
What is step 1 of MUST, how are the points distributed
BMI: greater than 20 = 0, 18.5-20 =1, less than 18.5= 2
What is step 2 of MUST, how are the points distributed
Weight loss: less than 5% =0, 5-10% =1, greater than 10% =2
What is step 3 of MUST, how are the points distributed
Acute Disease: If patient is acutely Ill and there has been or is likely to no nutritional intake for over 5 days = 2
Once all the scores are added up how is risk determined
0 equals low risk (routine clinical care), 1 equals medium risk (observe and monitor). 2 equals high risk (treat)
For the Malnutrition Screening Tool (MST) what point total is not as risk, at risk
0-1. 2 or more
What tool is usually used for the elderly
Nutrition Screening Initiative (NSI)
What tool is used for ICU patients
Nutritional Risk Screening
What are common elements in these screening tools
Food intake and weight loss
How is the NRS used
Left side: Determine highest score for Impaired Nutriotional Satus, Right Side: Determine highest score for Severity of Disease, Add scores from left and right sides (only 1 score from each side), If the total score greater than or equal to 5 parenteral nutrition support should be intitated early (48-72hrs)
What are the parameters of nutrition assesment
medical, nutrition and medication history, physical exam, anthtopometric measurements, lab data
What are ideal characterstics of nutrition assesment (A.S.P.E.N AND E.S.P.E.N)
Basic hallmark parameters, support a nutrition diagnosis, characterize severity, change as nutrition status changes, evidence based
What are the six characteristics that if present cause a diagnosis of malnutrition
Insufficient energy intake, Weight loss, Loss of muscle mass, loss of subcutaneous fat, localized or generalized fluid accumulation, decreased functional status (measured by hand grip strength)
How many of the characteristics need to be present if there is a diagnosis of malnutrition
2 of 6
What would be asked about when assessing insufficient energy intake
Quantity and type of foods, change in eating habits, compare estimated caloric needs with actual intake
What should be assessed when asking about weight loss
unintended loss, hydration status needs to be considered, edema or ascites
In the physical findings what should be looked at with regards to signs of inflammation
fever or hypothermia, non specific: hyperglycemia and tachycardia
